A Study Of Lateral Lymphonode Dissection With Autonomic Nerve Preservation Based On Total Mesorectal Excision For Rectal Cancer

Objective: To review the effect of urinary and male sexual function after Lateral Node Dissection with Autonomic Nerve Preservation Based of Total Mesorectal Excision for Rectal Cancer.Method: From January 2006 to September 2007, 58 patients (35 male, 23 female) with rectal cancer were performed with Lateral Node Dissection with Autonomic Nerve Preservation Based on Total Mesorectal Excision for Rectal Cancer in the Department of Gatric Colorectal and Anus Disease, the First Affiliated Hospital of Jilin University. On the basis of TME principle, the operation segregates the paries posterior of rectum sharply. During the course of disconnecting rectum, the doctor should pay attention to the position of autonomic nerve; whether the tumor invades the nerves and metastasis, it determines whether it retains the nerves. The main preservation nerves have:â‘ Superior hypogastric plexus nerve;â‘¡Hypogastric nerves;â‘¢Pelvic plexus;â‘£Pelvic splanchnic nerves.After the operation, 58 cases of rectal cancer subjected to D3 lymphadenectomy were analyzed retrospectively. Lymph nodes were classified as paratumoral regional and at the root of IMA (inferior mesenteric artery), and for tumors below the peritoneal reflection, lymph nodes (LN) situated in the lateralligament and mesorectum were examined as well. The metastatic rate was analyzed statistically.Results: The rate of metastasis was 43.1%, 18.9% and 10.3% in the paratumoral, the root of IMA and lateral node respectively. The metastatic rate of LNs around the root of IMA was 18.9%. The metastatic rate of LNs in the lateral ligament below the peritonealr eflection were 6.7%. There are no dead case and local recurrence in 2 years. There were significant differences in urinary and male sexual functions in styleâ… ,â…¡andâ…¢(P<0.05).Conclusion: In advanced rectal cancer below the peritoneal reflection, LNs tend to metastasize along the related blood vessels proximally, laterally and to the mesorectum. Extended lateral lymphadenectomy and total mesorectal excision (TME) should be included in cases below the peritoneal reflection. The PANP following radical excision for rectal cancer can reduce urinary and male sexual dysfunction, and improve the quality of life.